Healthcare Provider Details

I. General information

NPI: 1487926861
Provider Name (Legal Business Name): THOMAS E. CARSON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 LITTLE RD
TRINITY FL
34655-1743
US

IV. Provider business mailing address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-1908
  • Fax: 727-938-8693
Mailing address:
  • Phone: 727-938-1908
  • Fax: 727-938-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9655
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3391502
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME36578
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110547
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105368
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1658442
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108731
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS E. CARSON
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 727-938-1908